Observational experiences are those clinical learning experiences where students have no direct interaction in patient care. The student watches and may record or make written or verbal evaluations of the activities. An autopsy is an example.
Clinical preceptors may be used to enhance clinical learning experiences after a student has received clinical and didactic instruction in basic areas of nursing or within a course after a student has received clinical and didactic instruction in the basic areas of nursing for that course or specific learning experience. The preceptors serve as faculty-extenders since a faculty member can supervise 12 students in a clinical course when 2 students are assigned to preceptors. If a course uses clinical preceptors as the sole method of student instruction and supervision in clinical settings, faculty shall coordinate the preceptorship for no more than 24 students.
A preceptor has the same responsibilities as a clinical instructor and provides input to the formal evaluation by the assigned faculty. The program should have guidelines developed for the preceptor and the student (see preceptor guidelines on the BON web page). The preceptor should have a thorough understanding (and copies) of the student objectives and the faculty should always be available by pager, etc.
This term is used in Rule 215 for professional nursing education programs. Though the rule for RN programs does not specify a minimum number of clinical hours required in the program, it requires that the program provides a rationale for the ratio of contact hours assigned to classroom and clinical learning experiences. The recommended ratio is 3 contact hours of clinical learning experiences for each contact hour of classroom instruction. Basically, the student should spend 3 hours in clinical experiences for every 1 hour they spend in the classroom.
In order to calculate the hours in classroom and in clinical, the number of hours spent in the classroom per week will be multiplied times the number of semester/term weeks. For example, if a course meets for 3 hours a week for 16 weeks: 3 X 16 = 48 hours of classroom time.
In order to calculate the hours spent in clinical practice, the number of required hours spent in skills labs, simulation activities, and clinical settings each week will be multiplied times the number of semester/term weeks. For example, if the clinical requirements each week in one course equal 12 hours: 12 X 16 = 192 hours of clinical time.
The numbers can be calculated for each nursing course which has associated clinical experiences. A ratio can be determined by dividing the total clinical hours by the total classroom hours. The number of clinical hours should be at least 3 times the number of classroom hours.
Programs have the option of including all nursing courses in the calculation or including only nursing courses which have an associated clinical/laboratory experience. If programs use the latter option, the ratio should be a 1:3. Regardless of the ratio calculated, the program should have a rationale for the ratio.
See Guideline 3.7.2.a. Ratio of Clinical/Laboratory Hours to Classroom Hours in Professional Nursing Education Programs.
Is it necessary for nursing faculty to co-sign nursing students, nursing notes and other related documents utilized for charting?
The BON does not have rules specifically related to requiring co-signatures on nursing student charting and does not have an official stance regarding this issue. The healthcare facility may have policies about whether nursing students' charting requires co-signatures of nurses or instructors. The nursing education program may have policies related to this issue. Generally, when charting is co-signed, the indication is that the "co-signer" actually witnessed the nursing activities. The BON does not recommend co-signing documentation unless the "co-signer" is trying to emphasize that they witnessed and supervised the activity.
What tasks can a nursing student in a BON approved nursing education program perform during clinical learning experiences?
Under the supervision of faculty, the student nurse can perform functions for which he/she has the educational foundation to perform safely. The nursing faculty member is responsible to:
- supervise nursing care provided by others for whom the nurse is professional responsible [§217.11(1)(U)]
- maintain the safety of patients with whom the student interacts while maximizing a student's learning in the clinical setting [§217.11(1)(B)]
- be aware of any limitations placed on student participation in specific clinical areas that may be part of the contractual agreement between the nursing program and the clinical practice facility
Unprofessional conduct on the part of nursing faculty would be:
- failure of a clinical nursing instructor to adequately supervise or to assure adequate supervision of student experiences [§217.12(1)(G)]
The nurse student is not required to have a license under the exemption in the Nursing Practice Act §301.004(6) but can practice in a student nurse role under the supervision of a qualified member of the nursing faculty for purposes of meeting educational requirements for clinical practice. Since the student nurse is exempt, he/she is not practicing "under the faculty member's license."
How can clinical evaluation tools show progression of students' cognitive, affective, and psychomotor achievements?
Clinical evaluation tools should clearly indicate the expected behaviors of students in each clinical course. The expected behaviors should reflect the student's growth in knowledge base and skill level as the student progresses through the curriculum to eventually fulfill the program objectives. Some clinical objectives will be identified as critical behaviors, vital to completion of the program. Critical behaviors may include such things as safe administration of medications, reporting changes in client condition, and use of a systematic approach to planning, implementing, and evaluating client care. All clinical objectives must sufficiently vary from course to course in order to demonstrate progression through the curriculum.
Nursing programs may use clinical preceptors as faculty extenders for a portion of clinical learning experiences. If a faculty member uses preceptors in a course, the ratio of faculty to student can increase from 1:10 to 1:12 with 2 students being assigned to preceptors. In a course where the use of preceptors is the sole method of student instruction and supervision in clinical settings, the ratio of faculty to student can be increased to 1:24 with the faculty coordinating the preceptors.
In professional nursing (RN) programs, clinical teaching assistants can work with students in the clinical area under a Master's prepared faculty member and the ratio can be increased to 1:15.
How can a program utilize an MSN student majoring in nursing education and being mentored by a faculty member in a nursing program?
Since the MSN student usually holds a BSN, he/she may function as a clinical teaching assistant working under the supervision of the Master's prepared clinical faculty. He/she may also be asked to provide guest lectures under the supervision of the Master's prepared faculty member as long as the faculty member guides them and is in attendance at all times in student presentations.
How can vocational nursing educational programs meet the requirements of the rule to provide students with experiences in both acute and non-acute care settings for Pediatrics and Obstetrics when acute clinical opportunities in these areas are shrinking?
The rule requirements in Rule 214.9(b)(3)(A&B) and Rule 214.10(b) in regard to clinical learning experiences in Pediatrics and Obstetrics are:
"Nursing Care of Children. Experiences shall include care of children and meeting their needs in a variety of age groups in both the acute and non-acute care setting. Day care and clinic settings may be utilized as supplementary experience. Common health deviations, physical, psychological, and neurological handicaps, and nutritional needs shall be emphasized. Students shall have opportunities to develop understanding of normal growth and development and the influences of the family, home, church, school, and community. Student practice in caring for and understanding the needs of newborn infants shall also be included."
"Maternity Nursing. Opportunities shall be provided for students to gain an understanding of the psychological and physiological aspects of pregnancy, labor, and puerperium. Assisting mothers in the care of their infants shall be emphasized. A variety of settings, including clinics, organized maternity units, and maternity cases in non-segregated units, may be utilized for provision of maternity nursing experience."
"Clinical practice shall include actual hours of practice in clinical areas, clinical conferences, and/or simulated lab experiences."
What the rules do not require:
- a specific number of clinical hours in pediatric and obstetrics;
- that clinical learning experiences in pediatric and obstetrics occur only in acute care settings; or
- that all clinical learning experiences occur in an actual clinical setting.
Options for programs include, but are not limited to:
- day care, specialty home health agencies that focus on maternal/newborn care and/or pediatric care, physician offices, department of health well child areas, public school nurse clinics;
- well coordinated clinical scheduling utilizing a centralized scheduler either online or community based; and
- simulation activities from low fidelity to high fidelity.